Method and Apparatus for Harvesting Cartilage for Treatment of a Cartilage Defect

ABSTRACT

A method for treating a cartilage defect can include identifying an area of excessive boney growth on at least one of a femoral head and a femoral neck of a patient where the excessive boney growth area is covered with articular cartilage. A portion of the articular cartilage can be harvested from the identified area of excessive boney growth and an area of cartilage damage in an acetabulum of the patient can be identified. The harvested portion of the articular cartilage can be implanted into the identified area of cartilage damage in the acetabulum.

FIELD

The present teachings relate generally to a method for harvestingcartilage for treatment of a cartilage defect and, more particularly, toa method of harvesting cartilage for treatment of a cartilage defectsite in one of an acetabulum or a femoral head.

BACKGROUND

The statements in this section merely provide background informationrelated to the present disclosure and may not constitute prior art.

In an anatomy, such as a human anatomy, various portions of the body areinterconnected through soft tissues. For example, ligaments andcartilage interconnect various portions of the anatomy to provideselected articulations of adjacent bone portions. Over time, thecartilage may become weakened or damaged due to various reasonsincluding injury, fatigue, age, disease, etc. and may need to berepaired or replaced.

A cartilage autograft or allograft can be used to repair or replace thedamaged cartilage. When an autograft is used to repair the damagedcartilage, the autograft is typically obtained from another area orportion of the anatomy where the cartilage is healthy and may be underless strain, but may still be utilized in connection with thearticulation of an associated anatomical joint.

While these conventional cartilage autograft techniques work for theirintended purpose, there nevertheless exists a need in the art for animproved autograft technique for treating a cartilage defect.

SUMMARY

This section provides a general summary of the disclosure, and is not acomprehensive disclosure of its full scope or all of its features.

According to one exemplary aspect of the present teachings, a method fortreating a cartilage defect can include identifying an area of excessiveboney growth on at least one of a femoral head and a femoral neck of apatient where the excessive boney growth area is covered with articularcartilage. A portion of the articular cartilage can be harvested fromthe identified area of excessive boney growth and an area of cartilagedamage in an acetabulum of the patient can be identified. The harvestedportion of the articular cartilage can be implanted into the identifiedarea of cartilage damage in the acetabulum.

According to another exemplary aspect of the present teachings, a methodfor treating a cartilage defect can include identifying an area ofexcessive boney growth on at least a portion of one of a femoral headand a femoral neck of a patient where the excessive boney growth area iscovered with articular cartilage. At least one cartilage plug can beharvested from only the identified area of excessive boney growth wherethe at least one cartilage plug includes an articular cartilage layerand an underlying bone layer. The method can further include identifyinga cartilage defect site having an area of cartilage damage in at leastone of the acetabulum and the femoral head of the patient and preparingthe identified cartilage defect site for receipt of the at least oneharvested cartilage plug. The preparation can include forming a closedend bore through the respective area of cartilage damage, where theclosed end bore can have a width greater than a determined width of thearea of cartilage damage. The at least one harvested cartilage plug canbe implanted into the formed closed end bore of the at least oneprepared defect site such that the implanted cartilage plug is receivedin the closed end bore in an interference fit configuration. Theremaining excessive boney growth can be removed from the at least one ofthe femoral head and femoral neck after harvesting the at least onecartilage plug.

Further areas of applicability will become apparent from the descriptionprovided herein. It should be understood that the description andspecific examples are intended for purposes of illustration only and arenot intended to limit the scope of the present teachings.

DRAWINGS

The present teachings will become more fully understood from thedetailed description, the appended claims and the following drawings.The drawings are for illustrative purposes only and are not intended tolimit the scope of the present teachings.

FIG. 1 is a perspective view of a hip joint according to the presentteachings;

FIG. 2 is a perspective view of a hip joint with an excessive growth orbuild-up on the femoral neck and femoral head according to the presentteachings;

FIG. 3 is a perspective view illustrating a femoro-acetabularimpingement condition according to the present teachings;

FIG. 4 is a perspective view illustrating a labral tear in a rim of theacetabulum according to the present teachings;

FIG. 5 is a perspective view of a cartilage plug harvesting techniqueaccording to the present teachings;

FIG. 6 is another perspective view of the cartilage plug harvestingtechnique associated with the femoral head according to the presentteachings;

FIG. 7 is a perspective view of exemplary harvested cartilage plugsaccording to the present teachings;

FIG. 8 is another perspective view of the cartilage plug harvestingtechnique associated with the femoral head according to the presentteachings;

FIG. 9 is a perspective view of the cartilage plug harvesting techniqueassociated with the acetabulum according to the present teachings;

FIG. 10 is another perspective view of the cartilage plug harvestingtechnique associated with the acetabulum according to the presentteachings;

FIG. 11 is another perspective view of the cartilage plug harvestingtechnique associated with the acetabulum according to the presentteachings;

FIGS. 12A and 12B are views of an exemplary harvesting instrumentaccording to the present teachings; and

FIGS. 13A and 13B are views of an alternative exemplary harvestinginstrument according to the present teachings.

DETAILED DESCRIPTION

The following description is merely exemplary in nature and is notintended to limit the present disclosure, its application, or uses. Itshould be understood that throughout the drawings, correspondingreference numerals indicate like or corresponding parts and features.

Referring now to FIGS. 1-11 of the drawings, various methods aredisclosed according to the present teachings for treating a cartilagedefect associated with a hip joint of the anatomy. With particularreference to FIGS. 1-4, an exemplary hip joint 10 is shown where thefemoral head 14 is seated in the acetabulum 18 for articulationthereabout, as shown in FIG. 1. In certain circumstances, an abnormal orexcessive boney growth area or build-up 22 can occur in a region 26along the femoral head 14 and femoral neck 30, as generally shown inFIG. 2. The boney growth area 22 can result in an impingement conditiongenerally known as femoro-acetabular impingement (FAI) where the boneygrowth area 22 impinges on the acetabular rim surrounding the acetabulum18 when the femoral head 14 articulates relative thereto, as generallyshown in FIGS. 3 and 4. Such impingement can result in damage to thelabrum 34, such as a labral tear 38, as well as damage over time toarticular cartilage 42 of the acetabulum 18. As a result, it can bedesirable to remove the boney growth area 22 by way of burrs, milling orosteotomes.

With additional reference to FIGS. 5-11, a method for treating acartilage defect in the hip joint 10, including harvesting cartilagefrom the boney growth area 22, will now be described in greater detail.The method can include identifying the boney growth area 22 in theregion 26 extending about the femoral neck 30 and femoral head 14. Theboney growth area 22 can be covered with articular cartilage 54 thatalso covers the femoral head 14, as shown for example in FIG. 5. Theboney growth area 22 and articular cartilage 54 associated therewith canbe inspected to determine, for example, if there has been any damage tothe cartilage 54 as a result of FAI associated with the boney growtharea 22.

Once it has been determined that the articular cartilage 54, or aspecific area thereof, is suitable for harvesting, preparations can bemade to harvest a cartilage core or plug 58 from the boney growth area22. As will be described in greater detail below, the cartilage plug 58can include an articular cartilage layer 59 and a bone layer 61harvested from the respective articular cartilage layer 54 andunderlying bone of the boney growth area 22, as generally shown in FIGS.6 and 7. In one aspect of the present teachings, the cartilage plug 58can be harvested from only the excessive boney growth area 22. Thepreparations can include identifying a cartilage defect 62 in thefemoral head 14 and/or a cartilage defect 66 in the acetabulum 18, asgenerally shown in FIGS. 6 and 9, respectively. It should be appreciatedthat the harvested cartilage plug 58 could be also used to treat variouscartilage defects that may not necessarily be limited to the femoralhead 14 or acetabulum 18. Once the cartilage defect 62 and/or 66 hasbeen identified, a size of the defect can be determined, such as a width68 of the defect, for use in determining an appropriate instrument sizefor harvesting the cartilage plug 58 with an appropriate size to treatthe identified cartilage defect 62, 66.

With additional reference to FIGS. 12A-13B, the cartilage plug 58 can beharvested from the boney growth area 22 with any appropriate instrumentsuitable for such harvesting, such as the exemplary harvestinginstrument described in commonly owned pending U.S. application Ser. No.10/687,108, the entirety of which is hereby incorporated by referenceherein. The exemplary harvesting instrument can include a harvestingmember 74 generally defining a sharpened or coring end portion 78suitable for engaging the anatomy and an opposite end 82 configured forengagement with a handle or other suitable device capable of beingdriven with a mallet or the like. The harvesting member 74 can include agenerally elongated body 84 extending between the end portion 78 andopposite end 82 and can be formed of a suitable material so as to definean inner cannula 86. The inner cannula 86 can allow the cartilage plug58 or material to be harvested to be received therein.

The coring end 78 can be tapered and include a sharpened or cutting edge90. The cutting edge 90 can be used to cut into a selected portion ofthe anatomy, such as the articular cartilage 54 and underlying bone ofthe boney growth area 22. In addition, the harvesting member 74 caninclude demarcations 94 on an outer surface 98 thereof that can be usedto indicate or select a length or depth of a core portion, such ascartilage plug 58. A user may view the demarcations 94 on the exteriorof the harvesting member 74 to determine the depth of the harvestingmember 74 within the boney growth area 22. It will be understood thatthe harvesting member 74 may be formed of any appropriate material. Forexample, various biocompatible metals may be used that may be easilyformed and sharpened to form the sharpened edge 90 and inner cannula 86,where such materials can include biocompatible metals, ceramics andpolymers.

With particular reference to FIGS. 13A and 13B, an alternativeharvesting member 104 is illustrated according to the present teachings.Harvesting member 104 can also include an elongated body 108 thatdefines an inner cannula 112. The body 108 can include a cutting portion116 at one end and a tool engaging portion 120 at an opposite end. Thetool engaging portion 120 can be coupled to an appropriate tool (notshown) to rotate or drive the harvesting member such that the cuttingportion 116 can harvest the cartilage plug 58, as will be described ingreater detail herein. The cutting portion 116 can define a plurality ofcutting teeth 124, as shown for example in FIG. 13B. The cutting teeth124 can be defined in any appropriate manner such that they can berotated to harvest a selected portion of the articular cartilage 54 andunderlying bone of the boney growth area 22, such as cartilage plug 58.The harvested cartilage plug can be collected within the inner cannula112. It will be understood that demarcations, such as demarcations 94,can also be included on an outer surface of harvesting member 104.

Returning back to FIGS. 5-11, one of the harvesting members 74 or 104can be used to harvest the cartilage plug 58 from the boney growth area22, as generally shown in FIG. 5. If the harvesting member 74 is used,member 74 can be coupled to a handle and driven with a mallet or thelike into the boney growth area 22 to a desired depth indicated bydemarcations 94, as shown in FIG. 5. After the harvesting member 74 hasreached the desired depth, the harvesting member can be loosed orremoved from the boney growth area 22 by rotating the harvesting member74. The rotation can break off a core portion or cartilage plug 58 thatis positioned within the inner cannula 86 defined by the harvestingmember 74. On the other hand, if harvesting member 104 is used, member104 can be coupled to a tool for rotating the cutting teeth 124 suchthat the harvesting member can cut into the boney growth area 22 to thedesired depth indicated by demarcations 94 and harvest the cartilageplug 58.

Depending on the size of the boney growth area 22, one or more cartilageplugs 58 can be harvested therefrom. For example, three or morecartilage plugs 58 can be harvested from various portions of the boneygrowth area 22, as generally shown in FIG. 5. The harvested cartilageplugs 58 can include a cylindrical shape or form 130 having variousdiameters, such as a diameter of 5 mm, which may be required to treat asimilarly sized defect area in the femoral head 14 and/or acetabulum 18,as generally shown in FIG. 7. It should be understood that cartilageplugs of various sizes and numbers can be harvested from the boneygrowth area 22 as may be required to treat a cartilage defect or defectsof various sizes. In this manner, an overall size, shape and/or depth ofthe abnormal excessive boney growth area 22 that would need to beremoved to return the femoral head 14 and/or neck 30 to the naturalshape can be determined. Once this has been determined, variousdifferent sizes of cartilage plugs 58 can be harvested from specificareas of the excessive boney growth area 22 that is to be removed so asto optimize or maximize the amount of plugs that can be harvested. Forexample, if various cartilage defect sites have been identified thatinclude both shallow and deep depths, then cartilage plugs 58 havingshallow depths can be harvested from shallower areas of the excessiveboney growth area 22 so as to save deeper areas of the excessive boneygrowth area 22 for cartilage plugs that require a greater depth.

In addition, while the cartilage plug 58 has been described as having agenerally cylindrical form 130, it should be appreciated that the defectcan be harvested in various shapes including a generally conical shape134, as also shown in FIG. 7. The conical shape 134 can have a largerwidth or diameter at the articular cartilage layer 59 and a smallerdiameter at the end 138 of the underlying bone layer 61. Other possibleshapes include square, rectancular or triangular in cross-section. Theshapes could be formed, for example, with a reamer configured to bedriven or punched into the anatomy.

With particular reference to FIGS. 6 and 9-10, preparation of acartilage defect site 148 surrounding cartilage defect 62 in the femoralhead and/or a cartilage defect site 152 surrounding the cartilage defectin the acetabulum 18 will now be described in greater detail. Anexemplary coring reamer 156 or other suitable device can be used to reama selected portion of the cartilage defect site 148 and/or 152 toprepare the sites for implantation of the harvested cartilage plug orplugs 58. Appropriate reamers 156 are generally known and need not bedescribed in detail herein.

Reamer 156 can be used to ream a recipient socket in the form of aclosed end bore 160 in the cartilage defect site 148 and/or 152 thatsubstantially corresponds to a width of the harvested cartilage plug 58.Alternatively, the harvesting members 74, 104 can be provided with arange of sizes such that an appropriately sized harvesting member 74,104 can be selected to harvest a cartilage plug 58 having a width thatsubstantially corresponds to a width of the bore 160.

With particular reference to FIG. 6, the reamer 156 is shown beingadvanced toward cartilage defect site 148 and can ream the closed endbore 160, as generally shown with respect to another cartilage defectsite 148 where the closed end bore has already been reamed. Similarly,and with particular reference to FIGS. 9 and 10, the reamer 156 is shownbeing advanced toward the cartilage defect site 152 in FIG. 9 and can beused to form the closed end bore 160 in defect site 152, as generallyshown in FIG. 10. It should be appreciated that while only one cartilagedefect site 152 has been shown with respect to acetabulum 18, theacetabulum 18 can include multiple cartilage defect sites 152 that canbe treated according to the various methods of the present teachings.

The closed end bore 160 can include a shape and a width that correspondsto a shape and width of the harvested cartilage plug 58 such that thecartilage plug can be received in the reamed bore 160 in aninterference-fit or press-fit relationship. Alternatively, the closedend bore can have a width and form such that the cartilage plug 58 canbe received therein in a substantially slip-fit manner. The closed endbore can be reamed to a length or depth corresponding to the length ordepth of the cartilage plug 58. It should be appreciated that theindentified cartilage defect sites 148 and/or 152 can be prepared beforeor after the cartilage plug or plugs 58 are harvested.

Once the cartilage defect site 148 and/or 152 has been prepared, theharvested cartilage plug 58 can be implanted into the prepared site orsites, as generally shown in FIGS. 6 and 9 with respect to the femoralhead 14 and FIGS. 10-11 with respect to the acetabulum. The cartilageplug 58 can be implanted in the press-fit configuration in bore 160 suchthat a top or articular surface 164 of the articular cartilage layer 59is flush or substantially flush with a surface of the surroundingarticular cartilage 42 or 54 of the femoral head 14 and/or acetabulum18, as generally shown in FIG. 8 with regard to the femoral head 14 andFIG. 11 with regard to the acetabulum 18. Alternatively, the cartilageplug 58 can be implanted in the prepared bore 160 such that thearticular surface 164 is slightly proud of or above the respectivesurrounding articular cartilage such that the cartilage plug pressesinto bore 160 over time to be flush or substantially flush with thesurrounding articular cartilage. In addition, a fibrinogen glue or otherbiologic fixation agent can be used to enhance fixation of the cartilageplug 58 to the prepared bore 160 in the femoral head 14 and/oracetabulum 18.

With reference to FIGS. 6 and 8, a burr 170 or other appropriate toolcan be used to remove the abnormal or excessive boney growth area 22after the cartilage plug or plugs 58 have been harvested as describedabove. The burr 170 can be used to remove the boney growth area 22 so asto restore the sphericity of the femoral head 14, as well as remove anyboney growth area 22 on the femoral neck 30 so as to alleviate orsubstantially reduce FAI that can be caused by the boney growth orbuild-up area 22 before removal. The femoral head and neck regions underthe removed boney growth area 22 (shown in phantom in FIG. 8) can beresurfaced to restore the cortical bone to a smooth surface 174, as alsoshown in FIG. 8.

The technique described herein can allow for harvesting of cartilageplugs having an underlying bone layer from an area of abnormal excessiveboney growth that would normally be milled away to correct for FAI. Thiscan result in autograft material that can be used to correct forcartilage defects, sometimes caused by FAI. This technique can furtherreduce a need to harvest such cartilage plugs from other normal or goodareas of the anatomy thereby reducing any potential pain, longerrecovery time, etc., that may be associated therewith.

While one or more specific examples have been described and illustrated,it will be understood by those skilled in the art that various changesmay be made and equivalence may be substituted for elements thereofwithout departing from the scope of the present teachings as defined inthe claims. Furthermore, the mixing and matching of features, elementsand/or functions between various examples may be expressly contemplatedherein so that one skilled in the art would appreciate from the presentteachings that features, elements and/or functions of one example may beincorporated into another example as appropriate, unless describedotherwise above. Moreover, many modifications may be made to adapt aparticular situation or material to the present teachings withoutdeparting from the essential scope thereof.

1. A method for treating a cartilage defect, comprising: identifying anarea of excessive boney growth on at least one of a femoral head and afemoral neck of a patient, the excessive boney growth area being coveredwith articular cartilage; harvesting a portion of the articularcartilage from the identified area of excessive boney growth;identifying an area of cartilage damage in an acetabulum of the patient;and implanting the harvested portion of the articular cartilage into theidentified area of cartilage damage in the acetabulum.
 2. The method ofclaim 1, wherein harvesting a portion of the identified articularcartilage includes harvesting a cartilage plug from the excessive boneygrowth area, the cartilage plug including an articular cartilage layerand an underlying bone layer.
 3. The method of claim 2, whereinharvesting a cartilage plug from the excessive boney growth areaincludes harvesting the cartilage plug from only the excessive boneygrowth area.
 4. The method of claim 2, further comprising determining asize of the identified area of cartilage damage in the acetabulum; andselecting a harvesting instrument having a size sufficient to harvestthe cartilage plug with a size equal to or greater than the determinedsize of the identified area of cartilage damage in the acetabulum;wherein harvesting a cartilage plug includes driving the harvestinginstrument into the boney growth area to harvest the cartilage plug, thecartilage plug being received in an inner cannula of the harvestinginstrument.
 5. The method of claim 4, wherein harvesting the cartilageplug includes harvesting the cartilage plug such that the harvestedcartilage plug includes a width greater than a width of the closed endbore such that the harvested cartilage plug is implanted into the closedend bore in an interference fit configuration.
 6. The method of claim 2,further comprising preparing the identified area of cartilage damage inthe acetabulum to receive the harvested cartilage plug, said preparingincluding: selecting a reaming instrument having a cutting size equal toor larger than the size of the area of cartilage damage; aligning thereaming instrument with the area of cartilage damage; and reaming aclosed end bore through the area of cartilage damage and into theunderlying bone; wherein said closed end bore includes a width having adimension configured to receive the cartilage plug in an interferencefit.
 7. The method of claim 6, wherein implanting the harvested portionof the articular cartilage includes implanting the harvested cartilageplug into the prepared closed end bore such that an articular surface ofthe articular cartilage layer of the harvested plug is flush with orproud of the surrounding articular cartilage of the acetabulum.
 8. Themethod of claim 6, wherein harvesting a cartilage plug includesharvesting a cartilage plug having a selected length from a first enddefined by an articular surface of the articular cartilage layer to anopposite second end defined by the underlying bone layer; and whereinreaming a closed end bore includes reaming the closed end bore to alength substantially equal to the length of the harvested cartilageplug.
 9. The method of claim 2, wherein harvesting a cartilage plug fromthe excessive boney growth area includes harvesting a plurality ofseparate cartilage plugs from the excessive boney growth area; andwherein implanting the harvested portion of the articular cartilageincludes implanting at least one of the harvested plurality of cartilageplugs into the identified area of cartilage damage in the acetabulum.10. The method of claim 9, further comprising determining a size of aplurality of identified areas of articular cartilage damage, including awidth and depth thereof; wherein identifying an area of excessive boneygrowth further includes determining an amount of the identifiedexcessive boney growth to be removed to reshape the at least one of thefemoral head and femoral neck to substantially reduce femoro-acetabularimpingement and mimic a normal shape of the at least one of the femoralhead and femoral neck; and wherein harvesting a plurality of separatecartilage plugs from the excessive boney growth area includes harvestinga plurality of cartilage plugs having different widths and depths, andselecting an area of the excessive boney growth to harvest eachrespective cartilage plug of the plurality of cartilage plugs tomaximize an amount of the plurality of cartilage plugs that can beharvested from only the determined amount of excessive boney growth tobe removed.
 11. The method of claim 9, further comprising: identifyingan area of cartilage damage in an articulation area of the femoral head;preparing the identified area of cartilage damage in the femoral headfor receipt of one of the plurality or harvested cartilage plugs; andimplanting one of the plurality of harvested cartilage plugs into theprepared area of cartilage damage in the femoral head.
 12. The method ofclaim 2, wherein the harvested cartilage plug includes a cylindricalshape or a conical shape having a width at an articular surface of thearticular cartilage layer greater than a width of an opposite surface ofthe underlying bone layer.
 13. The method of claim 1, further comprisingremoving the remaining excessive boney growth on the at least one of thefemoral head and femoral neck to a shape of at least one of a normalfemoral head and femoral neck after harvesting a portion of thearticular cartilage from the identified area of excessive boney growth.14. A method for treating a cartilage defect, comprising: identifying anarea of excessive boney growth on at least a portion of one of a femoralhead and a femoral neck of a patient, the excessive boney growth areabeing covered with articular cartilage; harvesting at least onecartilage plug from only the identified area of excessive boney growth,the at least one cartilage plug including an articular cartilage layerand an underlying bone layer; identifying a cartilage defect site havingan area of cartilage damage in at least one of the acetabulum and thefemoral head of the patient; preparing the identified cartilage defectsite for receipt of the at least one harvested cartilage plug, thepreparation including forming a closed end bore through the respectivearea of cartilage damage, the closed end bore having a width greaterthan a determined width of the area of cartilage damage; implanting theat least one harvested cartilage plug into the formed closed end bore ofthe prepared defect site such that the implanted cartilage plug isreceived in the closed end bore in an interference fit configuration;and removing remaining excessive boney growth from the at least one ofthe femoral head and femoral neck after harvesting the at least onecartilage plug from the excessive boney growth.
 15. The method of claim14, wherein implanting the at least one cartilage plug further includesimplanting the at least one cartilage plug in a prepared cartilagedefect site of the acetabulum.
 16. The method of claim 14, whereinharvesting at least one cartilage plug from only the identified area ofexcessive boney growth includes: selecting a harvesting instrumentdefining an inner cannula and a first end configured to engage theanatomy, the inner cannula having a width greater than a width of theclosed end bore such that the harvested core plug can be implanted intothe closed end bore in the interference fit configuration; and drivingthe first end of the harvesting instrument into the identified boneygrowth area to harvest the cartilage plug, the cartilage plug beingreceived in the inner cannula.
 17. The method of claim 14, whereinimplanting the at least one harvested cartilage plug includes implantingthe at least one harvested cartilage plug into the closed end bore ofthe prepared cartilage defect site in the acetabulum such that anarticular surface of the articular cartilage layer of the at least oneharvested plug is proud of the surrounding articular cartilage of theacetabulum.
 18. A method for treating a cartilage defect, comprising:identifying an area of abnormal excessive boney growth on at least aportion of one of a femoral head and a femoral neck of a patient, theexcessive boney growth area causing femoro-acetabular impingement andbeing covered with articular cartilage; determining a size of theexcessive boney growth to be removed to substantially reduce thefemoro-acetabular impingement and mimic a normal shape of the at leastone of the femoral head and femoral neck; identifying a plurality ofcartilage defect sites each having an area of cartilage damage in one ofthe acetabulum and the femoral head of the patient; determining a size,including a width and depth, of each of the plurality of identifiedcartilage defect sites; identifying specific areas of the determinedsize of the excessive boney growth to be removed for harvestingcartilage plugs, the specific areas identified being selected tomaximize an amount of different sized cartilage plugs that can beharvested therefrom; harvesting a plurality of cartilage plugs from theidentified specific areas of excessive boney growth that is to beremoved, the plurality of cartilage plugs each including an articularcartilage layer and an underlying bone layer; preparing the identifiedplurality of cartilage defect sites for receipt of the plurality ofharvested cartilage plugs, the preparation including forming a closedend bore through each of the respective areas of cartilage damage;implanting the plurality of harvested cartilage plugs into thecorresponding formed closed end bores of the prepared plurality ofcartilage defect sites such that each implanted cartilage plug isreceived in a respective closed end bore in an interference fitconfiguration; and removing remaining excessive boney growth from the atleast one of the femoral head and femoral neck after harvesting theplurality of cartilage plugs from the excessive boney growth to mimicthe normal shape of the at least one of the femoral head and femoralneck.